Preoperative Tattooing Using Indocyanine Green in Laparoscopic Colorectal Surgery

Sang Jae Lee, Dae Kyung Sohn, Kyung Su Han, Byung Chang Kim, Chang Won Hong, Sung Chan Park, Min Jung Kim, Byung Kwan Park, Jae Hwan Oh, Sang Jae Lee, Dae Kyung Sohn, Kyung Su Han, Byung Chang Kim, Chang Won Hong, Sung Chan Park, Min Jung Kim, Byung Kwan Park, Jae Hwan Oh

Abstract

Purpose: The aim of the present study was to evaluate the usefulness of indocyanine green (ICG) as a preoperative marking dye for laparoscopic colorectal surgery.

Methods: Between March 2013 and March 2015, 174 patients underwent preoperative colonoscopic tattooing using 1.0 to 1.5 mL of ICG and saline solution before laparoscopic colorectal surgery. Patients' medical records and operation videos were retrospectively assessed to evaluate the visibility, duration, and adverse effects of tattooing.

Results: The mean age of the patients was 65 years (range, 34-82 years), and 63.2% of the patients were male. The median interval between tattooing and operation was 1.0 day (range, 0-14 days). Tattoos placed within 2 days of surgery were visualized intraoperatively more frequently than those placed at an earlier date (95% vs. 40%, respectively, P < 0.001). For tattoos placed within 2 days before surgery, the visualization rates by tattoo site were 98.6% (134 of 136) from the ascending colon to the sigmoid colon. The visualization rates at the rectosigmoid colon and rectum were 84% (21 of 25) and 81.3% (13 of 16), respectively (P < 0.001). No complications related to preoperative ICG tattooing occurred.

Conclusion: Endoscopic ICG tattooing is more useful for the preoperative localization of colonic lesions than it is for rectal lesions and should be performed within 2 days before laparoscopic surgery.

Keywords: Colonoscopic tattooing; Indocyanine green; Laparoscopic surgery; Localization.

Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1.
Fig. 1.
Visualization rate according to the intervals between preoperative indocyanine green tattooing and surgery.
Fig. 2.
Fig. 2.
(A1-2) Identified tattoos and (B1-2) invisibility of a nonpalpable colonic lesion marked with ICG: (A1) endoscopic view after tattooing, (A2) serosal appearance during laparoscopic surgery (tattoo-operation interval: 1 day), (B1) endoscopic view after tattooing, and (B2) invisible lesion during laparoscopic surgery (tattoo-operation interval: 5 days).
Fig. 3.
Fig. 3.
Visualization rate according to the tattoo site within the colon: (A) visualization rate of total tattoos by sites (n = 184), and (B) visualization rate of tattoos within 2 days before surgery (n = 179).

References

    1. Lacy AM, García-Valdecasas JC, Delgado S, Castells A, Taurá P, Piqué JM, et al. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet. 2002;359:2224–9.
    1. Clinical Outcomes of Surgical Therapy Study Group, Nelson H, Sargent DJ, Wieand HS, Fleshman J, Anvari M, et al. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med. 2004;350:2050–9.
    1. Cho YB, Lee WY, Yun HR, Lee WS, Yun SH, Chun HK. Tumor localization for laparoscopic colorectal surgery. World J Surg. 2007;31:1491–5.
    1. Park JW, Sohn DK, Hong CW, Han KS, Choi DH, Chang HJ, et al. The usefulness of preoperative colonoscopic tattooing using a saline test injection method with prepackaged sterile India ink for localization in laparoscopic colorectal surgery. Surg Endosc. 2008;22:501–5.
    1. Wexner SD, Cohen SM, Ulrich A, Reissman P. Laparoscopic colorectal surgery--are we being honest with our patients? Dis Colon Rectum. 1995;38:723–7.
    1. Frager DH, Frager JD, Wolf EL, Beneventano TC. Problems in the colonoscopic localization of tumors: continued value of the barium enema. Gastrointest Radiol. 1987;12:343–6.
    1. Montorsi M, Opocher E, Santambrogio R, Bianchi P, Faranda C, Arcidiacono P, et al. Original technique for small colorectal tumor localization during laparoscopic surgery. Dis Colon Rectum. 1999;42:819–22.
    1. Ohdaira T, Konishi F, Nagai H, Kashiwagi H, Shito K, Togashi K, et al. Intraoperative localization of colorectal tumors in the early stages using a marking clip detector system. Dis Colon Rectum. 1999;42:1353–5.
    1. Zmora O, Dinnewitzer AJ, Pikarsky AJ, Efron JE, Weiss EG, Nogueras JJ, et al. Intraoperative endoscopy in laparoscopic colectomy. Surg Endosc. 2002;16:808–11.
    1. Ponsky JL, King JF. Endoscopic marking of colonic lesions. Gastrointest Endosc. 1975;22:42–3.
    1. Hammond DC, Lane FR, Welk RA, Madura MJ, Borreson DK, Passinault WJ. Endoscopic tattooing of the colon. An experimental study. Am Surg. 1989;55:457–61.
    1. Price N, Gottfried MR, Clary E, Lawson DC, Baillie J, Mergener K, et al. Safety and efficacy of India ink and indocyanine green as colonic tattooing agents. Gastrointest Endosc. 2000;51(4 Pt 1):438–42.
    1. Lee JG, Low AH, Leung JW. Randomized comparative study of indocyanine green and India ink for colonic tattooing: an animal survival study. J Clin Gastroenterol. 2000;31:233–6.
    1. Hope-Ross M, Yannuzzi LA, Gragoudas ES, Guyer DR, Slakter JS, Sorenson JA, et al. Adverse reactions due to indocyanine green. Ophthalmology. 1994;101:529–33.
    1. Caesar J, Shaldon S, Chiandussi L, Guevara L, Sherlock S. The use of indocyanine green in the measurement of hepatic blood flow and as a test of hepatic function. Clin Sci. 1961;21:43–57.
    1. Hiratsuka M, Miyashiro I, Ishikawa O, Furukawa H, Motomura K, Ohigashi H, et al. Application of sentinel node biopsy to gastric cancer surgery. Surgery. 2001;129:335–40.
    1. Fu KI, Fujii T, Kato S, Sano Y, Koba I, Mera K, et al. A new endoscopic tattooing technique for identifying the location of colonic lesions during laparoscopic surgery: a comparison with the conventional technique. Endoscopy. 2001;33:687–91.
    1. Hammond DC, Lane FR, Mackeigan JM, Passinault WJ. Endoscopic tattooing of the colon: clinical experience. Am Surg. 1993;59:205–10.
    1. ASGE Technology Committee. Kethu SR, Banerjee S, Desilets D, Diehl DL, Farraye FA, et al. Endoscopic tattooing. Gastrointest Endosc. 2010;72:681–5.
    1. Miyoshi N, Ohue M, Noura S, Yano M, Sasaki Y, Kishi K, et al. Surgical usefulness of indocyanine green as an alternative to India ink for endoscopic marking. Surg Endosc. 2009;23:347–51.
    1. McArthur CS, Roayaie S, Waye JD. Safety of preoperation endoscopic tattoo with india ink for identification of colonic lesions. Surg Endosc. 1999;13:397–400.
    1. Askin MP, Waye JD, Fiedler L, Harpaz N. Tattoo of colonic neoplasms in 113 patients with a new sterile carbon compound. Gastrointest Endosc. 2002;56:339–42.
    1. Lee SH, Kim DY, Oh SY, Lee KJ, Suh KW. Preoperative localization of early colorectal cancer or a malignant polyp by using the patient’s own blood. Ann Coloproctol. 2014;30:115–7.
    1. Jeong O, Cho SB, Joo YE, Ryu SY, Park YK. Novel technique for intraoperative tumor localization during totally laparoscopic distal gastrectomy: endoscopic autologous blood tattooing. Surg Endosc. 2012;26:1778–83.
    1. Nagata J, Fukunaga Y, Akiyoshi T, Konishi T, Fujimoto Y, Nagayama S, et al. Colonic marking with near-infrared, light-emitting, diode-activated indocyanine green for laparoscopic colorectal surgery. Dis Colon Rectum. 2016;59:e14–8.
    1. Watanabe M, Tsunoda A, Narita K, Kusano M, Miwa M. Colonic tattooing using fluorescence imaging with light-emitting diode-activated indocyanine green: a feasibility study. Surg Today. 2009;39:214–8.

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